May 24, 2010

Functional assessment of the bladder.

Functional assessment of the bladder.: "

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Functional assessment of the bladder.

Ciba Found Symp. 1990;151:139-47; discussion 147-55

Authors: Nordling J

The urinary bladder has two functions: to store and to empty. A frequency-volume chart completed by the patient provides useful information about voiding intervals, possible factors provocative for incontinence, functional bladder capacity and daily urine volume. Filling cystometry is used primarily to evaluate reflex function in the storage phase, giving information about the presence or absence of detrusor instability and (in combination with urethral EMG) about detrusor-sphincter coordination. Information is also obtained about bladder sensation, bladder capacity and bladder compliance. Detrusor function during emptying is closely related to outflow conditions and therefore demands simultaneous registration of detrusor pressure and urinary flow rate. An inverse relation exists between detrusor pressure and flow rate, which means that reduced flow rate causes increased detrusor pressure for the same detrusor power. Underactive detrusor function will result in low detrusor pressure and low flow rate. The finding of a non-contractile detrusor may indicate psychogenic inhibition or a neurogenic lesion. Sacral evoked potentials and denervation supersensitivity tests may help to distinguish between these conditions.

PMID: 2226057 [PubMed - indexed for MEDLINE]
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May 21, 2010

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.: "

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Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.

Int J Urol. 2010 May 17;

Authors: Kim TG, Yoo KH, Jeon SH, Lee HL, Chang SG

Objectives: To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non-dominant and bilateral hemispheric stroke patients. Methods: We retrospectively reviewed the medical records of patients from a magnetic resonance imaging and urodynamic study. We identified 69 cases among 192 stroke patients who had undergone urodynamic study due to lower urinary tract symptoms from June 2003 to December 2008. Results: Among the analyzed variables in the urodynamic study, total bladder capacity, voided volume, postvoid residual urine volume, maximum flow rate, average flow rate, detrusor pressure at the maximum flow rate, and bladder compliance did not show statistically significant differences among dominant, non-dominant and bilateral hemispheric stroke patients groups (P > 0.05). The dominant hemispheric stroke group had detrusor overactivity in 64.2% of cases and detrusor underactivity in 35.8%; the non-dominant hemispheric stroke group had detrusor overactivity in 66.7% of cases and detrusor underactivity in 33.3%; and the bilateral stroke group had detrusor overactivity in 60.0% of cases and detrusor underactivity in 40.0% (P = 0.946). Conclusion: Urodynamic findings cannot be characterized by the laterality of the unilateral hemispheric ischemic lesion. There are no significant differences in lower urinary tract symptoms between dominant, non-dominant and bilateral hemispheric ischemic stroke patients.

PMID: 20482661 [PubMed - as supplied by publisher]
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May 17, 2010

The pathophysiology of urinary incontinence among institutionalized elderly persons.

The pathophysiology of urinary incontinence among institutionalized elderly persons.: "

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The pathophysiology of urinary incontinence among institutionalized elderly persons.

N Engl J Med. 1989 Jan 5;320(1):1-7

Authors: Resnick NM, Yalla SV, Laurino E

Although 1 million institutionalized elderly persons have urinary incontinence, little is known about the causes of this problem. We conducted clinical and physiologic studies to determine the causes of established incontinence in a representative sample of 605 institutionalized elderly persons (mean age, 89 years), of whom 40 percent were chronically incontinent of urine. Detailed urodynamic studies in 94 of the 245 incontinent patients (77 women and 17 men; 38 percent) showed that detrusor overactivity was the predominant cause in 61 percent, with concomitant impaired detrusor contractility present in half these patients. Other causes among women were stress incontinence (21 percent), underactive detrusor (8 percent), and outlet obstruction (4 percent). Among the relatively few men in this sample, outlet obstruction accounted for 29 percent of the cases. In 35 percent of the patients, at least two coexisting probable causes of incontinence were identified. Diagnoses among patients with impaired mobility or mentation differed little from those in unimpaired patients. We conclude that the pathophysiology of incontinence in this population is complex; that detrusor hyperreflexia with normal contractility ('uninhibited bladder') accounts for the minority of cases (29 percent), even among patients with dementia; and that the causes of incontinence are as diverse in severely impaired elderly persons as in those who are unimpaired.

PMID: 2909873 [PubMed - indexed for MEDLINE]
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May 12, 2010

[Bladder deformity in traumatic spinal cord injury patients]

[Bladder deformity in traumatic spinal cord injury patients]: "

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[Bladder deformity in traumatic spinal cord injury patients]

Hinyokika Kiyo. 1988 Jul;34(7):1173-8

Authors: Ogawa T, Yoshida T, Fujinaga T

Fifty-nine patients with traumatic spinal cord injury were subjected for the analysis of bladder deformity. Bladder deformity means bladder trabeculation and deformity of bladder shape such as pine tree shape. We classified bladder deformity into grade 0 (none), grade I (mild), grade II (moderate) and grade III (severe). Upper urinary tract deterioration was found in 0% of grade 0 (16 pts.), 32% of grade I (22 pts.), 80% of grade II (10 pts.) and 82% of grade III (11 pts.). We suggested that bladder deformity was one of the risk factors of upper urinary tract deterioration. High grade (greater than grade II) bladder deformity was found more frequently in complete injury than in incomplete injury. There was no differentiation between overactive bladder-overactive sphincter and underactive bladder-overactive sphincter. All patients with low compliance bladder had a high grade bladder deformity. There was a significant relationship between severity of urinary tract infection and severity of bladder deformity. Intermittent catheterization program was effective for preventing bladder deformity.

PMID: 3177138 [PubMed - indexed for MEDLINE]
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May 11, 2010

Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?

Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?: "


Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?

Int Braz J Urol. 2010 Mar-Apr;36(2):218-24

Authors: Valentini FA, Robain G, Marti BG, Nelson PP

PURPOSE: To determine why community-dwelling women aged 80 years or over were referred for urodynamic evaluation despite their advanced age and which urodynamic diagnosis was made. MATERIALS AND METHODS: One hundred consecutive females (80-93 years) were referred to our urodynamics outpatient clinic for evaluation of lower urinary tract symptoms (LUTS) between 2005 and 2008. Clinical evaluation comprised of a previous history of LUTS, previous medical history of neurological disease or dementia, pelvic floor dysfunction or prior pelvic surgery. Exclusion criteria were complete retention and severe dementia involving failure to understand simple instructions. Assessed items were results of uroflows (free flow and intubated flow), cystometry and urethral pressure profilometry, and final urodynamic diagnosis. RESULTS: The main complaint evoked by the patients was incontinence (65.0%) of which 61.5% was 'complicated' and urgency was reported by 70.0%. Interpretable free flow at arrival was very low (44.0%). Prevalence of detrusor overactivity was high, found in 45 patients of whom 16 had detrusor hyperactivity with impaired detrusor contractility. Detrusor overactivity and urgency were strongly associated (p = 0.004). Twenty-five patients had intrinsic sphincteric deficiency alone and 15 detrusor underactivity. CONCLUSION: In this particular community-dwelling with an elderly female population, urodynamics is easily feasible. Incontinence, mainly 'complicated' is the more frequent complaint and urgency the more frequent symptom. Urodynamic diagnosis underlines the high incidence of detrusor overactivity as well as impaired detrusor function.

PMID: 20450508 [PubMed - in process]
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May 9, 2010

Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up.

Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up.: "

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Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up.

Scand J Urol Nephrol. 1988;22(4):251-6

Authors: Klarskov P, Holm-Bentzen M, Larsen S, Gerstenberg T, Hald T

Partial cystectomy was performed for myogenic decompensated bladder with excessive residual urine in 11 patients, in whom training instructions and pharmacological treatment were unsuccessful. Postoperatively, the patients were followed for 2-13 years (median 4 years). Both symptoms and residual urine were reduced permanently. Urodynamic testing had demonstrated underactive detrusor function in all. The supposed etiology was infravesical obstruction in 4, overdistension due to sensory bladder paresis in 3 and unknown in 4. Histological examination of the resected bladders showed focal degeneration of the smooth muscle cells (detrusor myopathy) in 7, transmural edema and vast deposits of collagen in 8, mastocytosis in 3 and eosinophilic cystitis in 1. In conclusion we regard partial cystectomy an alternative to clean intermittent self-catheterization in selected patients with excessive residual urine.

PMID: 3238329 [PubMed - indexed for MEDLINE]
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May 8, 2010

[Vesical neuropathy in systemic vasculitis: 3 cases]

[Vesical neuropathy in systemic vasculitis: 3 cases]: "

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[Vesical neuropathy in systemic vasculitis: 3 cases]

Ann Med Interne (Paris). 1988;139(3):183-5

Authors: Amarenco P, Amarenco G, Guillevin L, Roullet E, Sobann M, Baudrimont M, Marteau R

Bladder neuropathy was diagnosed in 3 patients with systemic vasculitis (temporal arteritis: 1 case; periarteritis nodosa: 2 cases). Clinical characteristics were: dysuria, diminished or abolished bladder sensation leading to indolent bladder retention. Urodynamic investigation showed hypotonic and underactive detrusor, increased detrusor compliance, hyposensitive bladder, and/or overactive urethral closure. Needle electrode examination showed signs of denervation of periurethral muscles; sacral evoked latencies were increased, favouring pudenal nerve alterations. Symptoms and urodynamic abnormalities resolved following corticosteroid therapy. Clinical and therapeutic implications of bladder neuropathy in necrotizing vasculitis are emphasized.

PMID: 2904780 [PubMed - indexed for MEDLINE]
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May 6, 2010

Acute urinary retention in women: a prospective study of 18 consecutive cases.

Acute urinary retention in women: a prospective study of 18 consecutive cases.: "

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Acute urinary retention in women: a prospective study of 18 consecutive cases.

Scand J Urol Nephrol. 1987;21(1):29-31

Authors: Klarskov P, Andersen JT, Asmussen CF, Brenøe J, Jensen SK, Jensen IL, Lund P, Schultz A, Vedel T

Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.

PMID: 3589520 [PubMed - indexed for MEDLINE]
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May 5, 2010

De novo detrusor underactivity after laparoscopic radical prostatectomy.

De novo detrusor underactivity after laparoscopic radical prostatectomy.: "


De novo detrusor underactivity after laparoscopic radical prostatectomy.

Int J Urol. 2010 Apr 28;

Authors: Matsukawa Y, Hattori R, Komatsu T, Funahashi Y, Sassa N, Gotoh M

Objective: The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity. Methods: Records on pre- and postoperative urodynamic studies were retrospectively investigated in 110 patients who underwent laparoscopic radical prostatectomy. Patients exhibiting de novo detrusor underactivity were selected on the basis of an overt strain voiding pattern during the postoperative pressure flow study with detrusor pressure at a maximum flow rate <10 cm H(2)O accompanied by an increase in abdominal pressure. In these patients, a follow-up urodynamic study was performed to assess subsequent long-term changes in the bladder function. Results: Of the 110 patients, 10 (9.1%) were observed to exhibit de novo detrusor underactivity during the postoperative urodynamic study. During the voiding phase of the pre- and postoperative pressure flow study in these 10 patients, the mean detrusor pressure at maximum flow rate showed a significant decrease postoperatively from 57.6 to 3.0 cm H(2)O (P < 0.001), although the mean abdominal pressure at maximum flow rate significantly increased from 23.1 to 102.5 cm H(2)O (P < 0.001). The follow-up urodynamic study performed on seven patients at 36 months following surgery revealed no significant change in each urodynamic parameter. De novo detrusor underactivity persisted even over the long term following surgery, and no improvement in bladder function was observed. Conclusions: Detrusor contractility may be impaired during radical prostatectomy. Postoperative detrusor underactivity following radical prostatectomy seems to be an irreversible phenomenon persisting even over the long term.

PMID: 20438594 [PubMed - as supplied by publisher]
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May 4, 2010

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature.

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature.: "
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Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature.

J Pediatr Urol. 2007 Jun;3(3):195-9

Authors: Chandra Mishra S

OBJECTIVE: To identify whether a relationship exists between information gathered from voiding patterns, neurological status and radiological findings, and the actual dysfunction seen on cystometry in children with spina bifida. PATIENTS AND METHODS: Thirty consecutive children with spina bifida underwent clinical evaluation, urinary tract imaging and cystometry. The clinical and radiological data were correlated with actual bladder dysfunction. RESULTS: Cystometry was abnormal in 87% with overactive detrusor in 77%. Seventeen patients (57%) had significant residual urine of whom all had neurological or voiding abnormalities. Irrespective of radiological findings (abnormal in 53%), 90% of these patients had detrusor overactivity and 10% an underactive detrusor. In the group with insignificant residual urine (n=13), upper tract was abnormal in six (46%) of which four had neurological/voiding abnormalities and detrusor overactivity. The other two patients with normal neurologic status and voiding pattern had normal cystometry, but their upper tract damage was inexplicable. Of the patients with insignificant residual urine and normal upper tracts (n=7), four had neurologic/voiding abnormalities, three with an overactive detrusor and one underactive detrusor, and of the other three, one had an overactive detrusor. CONCLUSIONS: Patients with significant residual urine can be presumed to have detrusor overactivity and may be initially managed with clean intermittent catheterization and bladder relaxants. Cystometry is indicated if upper tract shows deterioration. In patients with insignificant residual urine and abnormal clinical evaluation or radiology, detrusor overactivity can be presumed and urodynamic studies deferred. Patients with insignificant residual urine, normal radiology but abnormal clinical findings must undergo initial cystometry.

PMID: 18947734 [PubMed]
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May 3, 2010

Sympathetic nervous system and dysfunction of the lower urinary tract.

Sympathetic nervous system and dysfunction of the lower urinary tract.: "

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Sympathetic nervous system and dysfunction of the lower urinary tract.

Clin Sci (Lond). 1986;70 Suppl 14:69s-76s

Authors: George NJ, Reading C

Careful clinical and investigative protocols allow the identification of a homogeneous group of patients with prostatodynia or 'anxious bladder syndrome' (underactive detrusor function). Psychophysiological studies and urodynamic measurements in such patients demonstrate remarkably consistent results, which, whilst lending support to the hypothesis that the sympathetic nervous system may effect bladder and urethral function, do not offer objective proof that adrenergic mechanisms are directly responsible for the observed dysfunctional state. observed dysfunctional state.

PMID: 3720192 [PubMed - indexed for MEDLINE]
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May 2, 2010

Urodynamic profile in myelopathies: A follow-up study.

Urodynamic profile in myelopathies: A follow-up study.: "

Urodynamic profile in myelopathies: A follow-up study.

Ann Indian Acad Neurol. 2009 Jan;12(1):35-9

Authors: Gupta A, Taly AB, Srivastava A, Thyloth M

AIMS: To study the significance of filling cystometry in assessment and management of neurogenic bladder in myelopathies and correlate neurological recovery and bladder management in the follow up. STUDY DESIGN: Retrospective analysis of reports of filling cystometry in patients with traumatic and non-traumatic myelopathy. SETTING: Neuro-rehabilitation unit of a tertiary care university hospital. METHODS: The study was carried out between September 2005 and June 2006 and included all subjects with myelopathy who underwent filling cystometry. ASIA impairment scale was used to assess neurological status during admission as well as in the follow up. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were correlated during the follow up after a minimum of 6 months. RESULTS: Fifty-two subjects (38 males, 14 females), mean age 33.26 +/- 14.66 years (10-80) underwent filling cystometry. Twenty patients had cervical, 24 had thoracic and 8 had lumbar myelopathy. Cystometric findings were overactive detrusor observed in 43 patients, (21 had detrusor sphincter dyssynergia (DSD), 22 without DSD) and areflexic/underactive detrusor in 9. Post-void residual (>15% of voided urine) was significant in 27 patients. Twenty-three patients (44%) reported for follow up (16 males, 7 females) after a mean duration of 9.04 +/- 2.44 months (6-15 months). Neurological recovery was seen in 61% cases, while 1 patient showed deterioration. Only 26% patients reported change in bladder management during follow up. Correlation between neurological recovery and bladder management was found to be insignificant (P > 0.05) using spearman correlation co-efficient. CONCLUSIONS: Filling cystometry is valuable for assessment and management of neurogenic bladder after myelopathy. No significant relationship was observed between neurological recovery and neurogenic bladder management in the follow up in the present study.

PMID: 20151007 [PubMed]
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